The Effects of Adverse Childhood Experiences (ACEs) and Gender on Trauma-Focused Intervention Outcomes

Background and Purpose: The prevalence of childhood exposure to trauma and its link to negative behavioral and health outcomes is well documented. Studies have found that Adverse Childhood Experiences (ACEs) are related to increased risk of mental health, substance use, and chronic disease (Anda et al., 2008; Crouch et al., 2017; Taillieu et al., 2016). Although there is considerable evidence of the negative impact of ACEs, very few studies have empirically examined the effect of ACEs on the intervention outcomes. Moreover, there are gender differences in the types and numbers of ACEs and vulnerability to developing traumatic symptoms, which relates to intervention outcomes (Ascienzo, et al., 2021). This study examined the effects of ACEs on a trauma-informed treatment intervention and the gender differences on the intervention outcomes.

Methods: This study includes data from children who received a trauma-informed intervention using the Attachment, Self-Regulation, and Competency (ARC) framework. The ARC framework is a trauma-focused intervention model aimed at addressing the three core domains impacted by trauma: attachment, self-regulation, and developmental competencies (Blaustein & Kinniburgh, 2010). ACE scores are measured as a total across 10 items and different types (maltreatment vs. family dysfunction) at intake. Children’s trauma-related symptoms are assessed at intake and every 90 days thereafter to identify any changes in symptoms using the ARC framework. In order to examine the changes of traumatic symptoms over time, the study was limited to children who have at least three assessment time points. A total of 362 children are included for the current analyses. Multilevel modeling using SAS PROC MIXED was used to examine the effects of ACEs on ARC outcome domains and the gender effects on the treatment outcomes on the ARC domains.

Results: Results indicate that children’s trauma related symptoms significantly decreased in all ARC outcome domains in general. Girls showed significant decreases in attachment and competency domains (not in self-regulation domain), while boys showed significant decreases in self-regulation and competency domains (not in attachment domain). When children have more than 7 ACE scores, there is no significant intervention effects in the self-regulation and competency domains. Child maltreatment experiences have significant effects on self-regulation domain, while family dysfunction does not have effect on three domains.

Conclusion and Implications: The study demonstrates the potential importance of high number of ACEs and maltreatment experiences on trauma-focused intervention outcomes. It also suggests that practitioners should pay attention to gender differences that may influence the assessment of traumatic symptoms when developing treatment plans, as this will influence treatment outcomes.